The mass vaccination programs, which have developed in response to the current COVID-19 pandemic, have for the most part been a great success with a few complications. However, we report on an “unusual adverse event,” which required dental/oral surgery consultation.
Case Report
A healthy 36-year-old male presented to the Emergency Room following a post injection syncopal episode at a COVID-19 vaccine center. He had a laceration on his chin and tongue (Fig. 1) and had difficulty talking and opening his jaw. A panorex (Fig. 2) and a CT scan showed he had bilateral mandibular condylar fractures (Fig. 3) – the left condylar head was crushed and displaced medially while the right condylar head fragmented in place. The patient was edentulous which made for limited treatment options – wiring of dentures to the jaws with a short period of elastic therapy, with soft diet and pain management or soft diet and pain management. The patient chose the latter with close monitoring. Two months post-injury the mouth opening has been restored with minimal deviation.
Fig. 1
Fig. 2
Fig. 3
Vasovagal or syncopal events in response to injections are a recognized phenomenon in medical and dental settings. In fact, it is the most common emergency in the dental office.1 Syncope is defined as an abrupt transient, short-term loss of consciousness and postural tone, followed by spontaneous recovery. Rarely does this lead to more serious complications, although in a mass vaccination setting such events may be inevitable. Syncope after COVID-19 vaccine was reported as 8.2 episodes per 100,000 doses, in comparison to 0.05 episodes per 100,000 doses of influenza doses.2 Injuries were more common in the younger age group (11-18 years old) with the older patients at higher risk for major injuries (ie, head injuries).3,4 This is supported by Ito et al., that maxillofacial fractures, secondary to falls from loss consciousness, are more severe than from trips, stumbling or falling.5 Monitoring patients in the immediate post-vaccination period for at least 15 minutes plus providing a beverage, snack, and reassurance has been shown to decrease syncope related injuries.
Having access to an interdisciplinary team, including dentistry, has allowed us to proceed with a comprehensive vaccination program without comprising patient care.
Oral Health welcomes this original article.
References
- Haas DA. Management of medical emergencies in the dental office. Conditions in each country, the extent of treatment by the dentist. Anesth Prog 53(1):20-24, 2006
- Hause AM, Gee J, Johnson T et al. Anxiety-related adverse event cluster after Janssen COVID-19 vaccination – Five U.S.mass vaccination sites April 2021. MMWR Morb Mortal Wkly Rep 70(12):685-688, 2021
- Jorge JG, Raj SR, Teixeira JAC et al. Likelihood of injury due to vasovagal syncope: a systemic review and meta-analysis EP Europace 23 (7) 1092-1099, 2021. https://doi.org/10.1093/europace/euab041
- Jorge JG, Pourmazari P, Raj SR et al. Frequency of injuries associated with syncope in the prevention of syncope trial. EP Europace 22 (12)1896–1903, 2020 https://doi.org/10.1093/europace/euaa246
- Ito R, Kubota K, Yaguchi S et al. Falls due to loss of consciousness are associated with maxillofacial fracture severity. J Oral Maxillofac Surg 78(3):423-429, 2020
About the Author
Bruce R Pynn is Oral Health’s editorial board member for oral and maxillofacial surgery. He maintains a private practice in Thunder Bay, ON. He is an Assistant Professor, North Ontario School of Medicine, Lakehead University, and Chief of Dentistry, Thunder Bay Regional Health Sciences Center. Dr. Pynn can be reached at b.pynn@shaw.ca
Ian Dobson is Staff Anesthetist at Thunder Bay Regional Health Sciences Center, Thunder Bay, Ontario, and is an Assistant Professor, North Ontario School of Medicine, Lakehead University.
